Use of high‐risk human papillomavirus testing in patients with low‐grade squamous intraepithelial lesions

• Published in: Cancer cytopathology Vol. 119; no. 4; pp. 228 - 234
• Main Authors: Levi, Angelique W., Harigopal, Malini, Hui, Pei, Schofield, Kevin, Chhieng, David C.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 25-08-2011; Wiley
• Subjects: Adult; Biological and medical sciences; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - prevention & control; Carcinoma, Squamous Cell - virology; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - prevention & control; Cervical Intraepithelial Neoplasia - virology; DNA, Viral - genetics; Early Detection of Cancer; Female; Female genital diseases; Follow-Up Studies; follow‐up of LSIL; gynecologic cytology; Gynecology. Andrology. Obstetrics; high‐risk human papillomavirus (HPV) testing; Humans; Infectious diseases; Medical sciences; Middle Aged; Papanicolaou (Pap) test; Papillomaviridae - isolation & purification; Papillomavirus Infections - diagnosis; Papillomavirus Infections - virology; Polymerase Chain Reaction; Prognosis; Risk Factors; Sensitivity and Specificity; triage of low‐grade squamous intraepithelial lesion (LSIL); Tumors; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Uterine Cervical Neoplasms - virology; Vaginal Smears; Viral diseases; Human; High risk; Premalignant lesion; Papovaviridae; Medical screening; Female genital diseases; Infection; Papillomavirus; Virus; Human papillomavirus; Cervical dysplasia; Low malignancy; Viral disease; Squamous intraepithelial lesion; Adult; Female; Uterine cervix diseases; Public health; Age; Low grade
• ISSN: 1934-662X; 1934-6638
• DOI: 10.1002/cncy.20172

BACKGROUND
The role of testing for high‐risk human papillomavirus (HR HPV) when triaging women with a cytologic diagnosis of low‐grade squamous intraepithelial lesion (LSIL) has not been well established. The objective of the current study was to correlate the status of HR HPV with the incidence of cervical intraepithelial neoplasia 2 and more severe lesions (CIN 2+) on tissue follow‐up in women with LSIL.
METHODS
A total of 1046 women with LSIL and HR HPV testing were identified in the database of a large teaching hospital within a 12‐month period. HR HPV testing was performed using the Hybrid Capture 2 assay with 1 relative light unit/cutoff as the cutoff.
RESULTS
Of the 1046 women with LSIL and concurrent HR HPV testing, 82.3% tested positive for HR HPV, 91.1% of whom were women aged < 30 years and 73% of whom were women aged ≥ 30 years (P < .001). Cytologic and/or histologic follow‐up was available in 979 (93.6%) women; 25.5% had negative follow‐up, 62.5% were found to have CIN 1 lesions, and 12.0% had CIN 2+ lesions. The sensitivity and negative predictive value of HR HPV status as a marker of CIN 2+ lesions were 98.3% and 98.9%, respectively. The colposcopy rate was 73.3% and 96.9% for women aged ≥ 30 years and women aged < 30 years, respectively (P = .01).
CONCLUSIONS
Using 1 RLU/CO as the cutoff value, HR HPV testing was found to be highly sensitive for detecting CIN 2+ lesions in women with LSIL. The colposcopy rate was significantly lower in women aged ≥ 30 years compared with women aged < 30 years. Triaging with HR HPV testing may be indicated in women aged ≥ 30 years with LSIL cytology, but not in women aged < 30 years. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.
High‐risk human papillomavirus testing is highly sensitive for detecting cervical intraepithelial neoplasia 2 and more severe lesions in women with low‐grade squamous intraepithelial lesions. Its use as a triaging tool may be indicated in women aged ≥ 30 years.